Diagnosing non-radiographic axial spondyloarthritis: challenges and the role of advanced practice physiotherapists
Kirsty Monahan, Joe DavisBackground
Non-radiographic and radiographic axial spondyloarthritis are typically diagnosed by rheumatologists through comprehensive clinical assessment, as no definitive diagnostic test exists. Advanced practice physiotherapists in rheumatology may have the expertise to support diagnosis, potentially reducing rheumatology waiting times and diagnostic delay.
Aims
This review explores the clinical assessment and diagnostic pitfalls of non-radiographic axial spondyloarthritis and examines the potential role of advanced practice physiotherapists in rheumatology in diagnosing the condition.
Methods
A scoping literature search was performed using Medline and CINAHL databases from January 2019 to May 2024. In addition, guidance and quality standards from the National Institute for Health and Care Excellence, the Cochrane Database, and citation searching were used.
Findings
The inappropriate use of classification criteria as diagnostic criteria may lead to false-positive diagnoses. A thorough clinical assessment, including the appropriate interpretation of imaging and blood test results, can improve diagnostic accuracy. Advanced practice physiotherapists specialising in rheumatology are well positioned to undertake this role.
Conclusions
Integrating rheumatology advanced practice physiotherapists within rheumatology services to assess and diagnose axial spondyloarthritis is an appropriate approach.
Implications for practice
This model of care could enable rheumatologists and specialty doctors to focus on more complex cases, potentially improving access and reducing waiting times for patients.